Changes in Hemoglobin Concentrations Post-immunoglobulin Therapy in Patients with Kawasaki Disease: A Population-Based Study Using a Claims Database in Japan
Changes in Hemoglobin Concentrations Post-immunoglobulin Therapy in Patients with Kawasaki Disease: A Population-Based Study Using a Claims Database in Japan
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DOI：
10.1007/s40272-018-0316-y
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发表时间：
2018-10
期刊：
影响因子：
3.7
通讯作者：
Masato Takeuchi;S. Ito;Masaki Nakamura;K. Kawakami
中科院分区：
文献类型：
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作者：
Masato Takeuchi;S. Ito;Masaki Nakamura;K. Kawakami
背景：我们试图通过评估血红蛋白（Hb）动态和确定输血风险来量化川崎病（KD）患者高剂量静脉注射免疫球蛋白（IVIG）治疗后的贫血程度。方法：我们分析了来自日本230家医院的住院患者数据。除了行政记录外，该数据库还包括一些患者的实验室结果。我们检索年龄≤18岁且诊断为KD（国际疾病与相关健康问题统计分类，第10版，代码M30.3）且接受高剂量（≥1 g/kg） IVIG治疗的个体。主要结果测量是ivig治疗后实验室结果可用的患者Hb动态。次要结局包括整个队列中Hb值低于指定阈值（例如，1 g/dL）的患者比例和接受红细胞输注的人数，由日本行政代码确定。结果8262例接受高剂量IVIG治疗的KD患者中有979例可获得实验室数据。样条曲线评估Hb动态显示，IVIG输注后1-2天通常发生轻度贫血，此后恢复到基线。在21.8%和4.3%的患者中分别发现血红蛋白>下降1 g/dL和>下降2 g/dL。8262例KD患者中有2例在IVIG治疗后输血（发生率0.024%，95%可信区间0.003-0.087），但输血指征无法从我们的记录中确定。结论日本KD患者在ivig治疗后常出现轻度贫血，但严重贫血需要输血的患者很少。
BackgroundWe sought to quantify the degree of anemia after high-dose intravenous immunoglobulin (IVIG) therapy in patients with Kawasaki disease (KD) by assessing hemoglobin (Hb) dynamics and determining the risk of transfusion.MethodsWe analyzed data from a database containing inpatient data collected from 230 hospitals in Japan. In addition to administrative records, this database included laboratory results for some patients. We searched for individuals aged ≤ 18 years with a diagnosis of KD (International Statistical Classification of Diseases and Related Health Problems, 10th revision, code M30.3) who had received high-dose (≥ 1 g/kg) IVIG therapy. The primary outcome measure was post-IVIG therapy Hb dynamics in patients for whom laboratory findings were available. Secondary outcomes included the proportion of patients whose Hb value decreased below a specified threshold (e.g., 1 g/dL) and the number who received red blood cell transfusions, identified by a Japanese administrative code, in the whole cohort.ResultsLaboratory data were available for 979 of 8262 patients with KD receiving high-dose IVIG. Hb dynamics assessed on spline curves showed that mild anemia commonly occurred 1–2 days after IVIG infusion and returned to the baseline thereafter. Declines of Hb > 1 g/dL and > 2 g/dL were found in 21.8% and 4.3% of patients, respectively. Two of the 8262 individuals with KD had received transfusions after IVIG therapy (incidence rate 0.024%; 95% confidence interval 0.003–0.087), but the indication for transfusion could not be determined from our records.ConclusionsAlthough mild anemia commonly occurred post-IVIG therapy in Japanese individuals with KD, severe anemia necessitating transfusion was rare in these patients.